DOCSLIB.ORG

Medication Related Osteonecrosis of Jaw

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Medication Related Osteonecrosis of Jaw Jemds.com Case Report Medication Related Osteonecrosis of Jaw Prasanthi Sitaraman1, Arvind Muthukrishnan2 1Department of Oral Medicine and Radiology, Saveetha Dental College, Tamilnadu, India. 2Department of Oral Medicine and Radiology, Saveetha Dental College, Chennai, Tamilnadu, India. PRESENTATION OF CASE A 41 year old female patient reported with the complaint of pain in the right posterior Corresponding Author: mandibular region for the past 5 months. History revealed that patient was diagnosed Dr. Prasanthi Sitaraman. with breast cancer before 4 years following which she underwent mastectomy, Department of Oral Medicine and radiotherapy and chemotherapy. PET / CT taken post chemotherapy showed bone Radiology, Saveetha Dental College, Saveetha Institute of Medical and Technical metastasis to the lumbar spine for which she was prescribed I.V. zoledronic acid to Sciences (SIMATS), 162, Poonamallee High be administered every 3 months. Patient was under I.V. zoledronic acid for a total of Road, Chennai - 600077, Tamilnadu, India. 36 months. E-mail: [email protected] Patient underwent surgery for extraction of impacted lower third molar before 7 months. The extraction site did not completely heal following which the tooth DOI: 10.14260/jemds/2020/602 adjacent to the extraction site became mobile. The mobile tooth was also extracted before 5 months following which she developed pain and swelling in the region. How to Cite This Article: Patient was diagnosed with osteoradionecrosis and underwent curettage and Sitaraman P, Muthukrishnan A. Medication related osteonecrosis of jaw. J Evolution antiseptic dressing for 2 months. However, there was no reduction in pain. Pain was Med Dent Sci 2020;9(37):2770-2772, DOI: gradual in onset, continuous, gnawing, in the extraction site, aggravated by 10.14260/jemds/2020/602 mastication and relieved by medication. On clinical examination, non – healing extraction socket was evident in 47, 48 Submission 13-06-2020, region. A single, oval ulcer measuring about 0.5 cm * 0.5 cm was evident in the medial Peer Review 07-08-2020, surface of the retro molar area in 48 region. The margins of the ulcer was well – Acceptance 13-08-2020, Published 14-09-2020. defined and the floor was covered with granulation tissue with erythematous surrounding mucosa. No discharge is evident from the ulcer. On palpation, the ulcer Copyright © 2020 Prasanthi Sitaraman et is tender. The floor of the ulcer revealed necrotic bone (Figure 1). al. This is an open access article distributed The patient was subsequently subjected to Orthopantomogram (OPG) and under Creative Commons Attribution Computed tomography (CT) (Figure 2). OPG shows missing 47, 48 and loss of alveolar License [Attribution 4.0 International (CC bone and extending from the distal surface of 46 and posteriorly to the retromolar BY 4.0)] region, inferiorly to about 2 mm from the mandibular canal. The affected bone has irregular margins and comparatively radiolucent to the surrounding bone on the posterior margin. The CT – axial, coronal, sagittal sections with 3D reconstruction showed post-operative bone defect in the lower right second and third molar region from the previous curettage. In consultation with the physician, intravenous bisphosphonate was discontinued. Antibiotics clindamycin (300 mg, B.I.D.) was coupled with pentoxiphylline (400 mg, O.D.) with supplementary povidone iodine and Chlorhexidine gluconate mouth gargle was prescribed. The exposed bone was subsequently surgically removed after 15 days of medical management (Figure 3). Based on the chief complaint, medical history and radiographic findings, a diagnosis of stage 2 Medication Related Osteonecrosis of Jaw (MRONJ) was given. The patient is under regular follow-up. Anti-resorptive drugs are those drugs that reduce bone loss by decreasing osteoplastic bone resorption. They are used in the treatment of various medical conditions, including osteoporosis, multiple myeloma, and breast cancer with skeletal metastasis, because they reduce bone pain, hyperkalaemia, and the risk of pathologic fractures. There are 5 classes of antiresorptive drugs, of which bisphosphonates are increasingly associated with Osteonecrosis of jaw. This condition was named as Bisphosphonate related osteonecrosis of jaw (BRONJ), later renamed as Medication related osteonecrosis of jaw (MRONJ) following identification of non-bisphosphonate related aetiology such as antiangiogenic agents such as bevacizumab, aflibercept and sunitinib. J Evolution Med Dent Sci / eISSN - 2278-4802, pISSN - 2278-4748 / Vol. 9 / Issue 37 / Sept. 14, 2020 Page 2770 Jemds.com Case Report This case report describes a 41-year-old female patient on zoledronic acid therapy following bone metastasis from breast cancer who developed osteonecrosis of jaw following extraction of right lower wisdom teeth. Careful history taking to review medication in oncology patients with history of chemotherapy (antiresorptive drugs) and liaison with medical oncologist prior to any invasive dental treatment on these patients with bisphosphonates / denosumab / antiangiogenic drugs is absolutely necessary to prevent the occurrence of consequences such as MRONJ. Role of oral medicine physicians in prevention and treating osteochemonecrosis is inevitable as early prevention and accurate treatment increases quality of life in these groups of patients. Antiresorptive drugs are osteotropic agents used for their ability to prevent bone resorption in patients with osteoporosis, metabolic bone diseases and hypercalcemia. The classes of antiresorptive drugs are bisphosphonates, oestrogens, selective oestrogen receptor modulators, calcitonin, and monoclonal antibodies. There are three generations of bisphosphonates, most potent of these drugs are the second and the third generation - alendronate and zoledronate1. Other common indications for the use of BPNs is metastatic cancer of bone. First described by Marx in 2003, osteonecrosis of jaw is the most frequently reported adverse effect of BPNs2. The terms bisphosphonate - related osteonecrosis of the jaw (BRONJ) and antiresorptive agent related ONJ (ARONJ) has been advocated. The AAOMS position paper (2014) favours the use of the term medication-related osteonecrosis of the jaw (MRONJ) after identification of other drugs like anti – angiogenic drugs as the cause of osteonecrosis3. MRONJ is considered a severe adverse drug reaction, consisting of progressive bone destruction in the maxillofacial region of patients. Patients under zoledronic acid and denosumab have shown to have increased risk of developing MRONJ than other antiresorptive drugs3. This case study illustrates a 41-year-old female patient under I.V. zoledronic acid who reported with jaw pain post extraction of wisdom tooth. Figure 2. OPG and CT Sections Showing Affected Bone in the Region Distal to 46 Figure 1. Floor of the Ulcer Revealing Necrotic Bone Figure 3. Post-Operative Photograph Following Surgical Curettage of the Necrotic Bone J Evolution Med Dent Sci / eISSN - 2278-4802, pISSN - 2278-4748 / Vol. 9 / Issue 37 / Sept. 14, 2020 Page 2771 Jemds.com Case Report prior to any invasive dental treatment on these patients and DISCUSSION treating with bisphosphonates / denosumab / antiangiogenic drugs is absolutely necessary to prevent the occurrence of MRONJ is a consequence of use of antiresorptive drugs and consequences such as MRONJ. Role of oral medicine physicians antiangiogenic drugs for varied therapeutic indications. The in prevention and treating osteochemonecrosis is inevitable as pathophysiology is not well understood. However, multiple early prevention and accurate treatment increase the quality hypothesis has been put forward to elucidate the localization of life in these groups of patients. to the jaws and not the other bones of the body. These include altered remodelling, trauma, suppression of osteoclastic Financial or Other Competing Interests: None. activity, inhibition of angiogenesis, decreased vascularity to the jaw bone and suppression of immunity due to previous treatments for treating cancer.4 Risk factors like the drug, REFERENCES mode of administration, length of therapy, age and gender of the patient, other co – morbidities, local factors like trauma from dentures, inflammatory disease have to be considered. [1] Drake MT, Clarke BL, Khosla S. Bisphosphonates: Multiple studies have reported that in about 52 – 61 % of cases, mechanism of action and role in clinical practice. Mayo dental extraction acts as trigger for MRONJ which is similar to Clin Proc 2008;83(9):1032-45. that of our case.5,6 Detailed history with the duration of [2] Marx RE. Pamidronate (Aredia) and zoledronate treatment with antiresorptive and antiangiogenic medication (Zometa) induced avascular necrosis of the jaws: a has to be recorded prior to any dental procedure. growing epidemic. J Oral Maxillofac Surg Communication with the oncologist / physician is 2003;61(9):1115-7. unquestionably needed to prevent complications such as [3] Ruggiero SL, Dodson TB, Fantasia J, et al. American MRONJ.7 association of oral and maxillofacial surgeons position Case definition of BRONJ / ARONJ / MRONJ has not paper on medication-related osteonecrosis of the jaw- changed since the AAOMS position paper, 2009.3,8 Presence 2014 update. J Oral Maxillofac Surg 2014;72(10):1938- current or previous treatment with a bisphosphonate, exposed 56. bone in the maxillofacial region that has persisted for more [4] Rosella D, Papi P, Giardino R, et al. Medication-related than 8 weeks and no history
Load more

Recommended publications
  • Related Osteonecrosis of the Jaw in Patients with Sjögren's Syndrome
    Open access Research BMJ Open: first published as 10.1136/bmjopen-2018-024655 on 13 February 2019. Downloaded from Increased risk of bisphosphonate- related osteonecrosis of the jaw in patients with Sjögren’s syndrome: nationwide population-based cohort study Min-Tser Liao,1,2 Wu-Chien Chien,3,4,5 Jen-Chun Wang,6 Chi-Hsiang Chung,3,4,7 Shi-Jye Chu,8 Shih-Hung Tsai6,9 To cite: Liao M-T, Chien W-C, ABSTRACT Strengths and limitations of this study Wang J-C, et al. Increased Objective The aim of this study was to explore whether risk of bisphosphonate- patients with Sjögren’s syndrome (SS) were susceptible ► The strength of our study is its population-based related osteonecrosis of to bisphosphonate (BP)-related osteonecrosis of the jaw the jaw in patients with cohort design with a large number of patients and (BRONJ) after tooth extraction in the entire population of Sjögren’s syndrome: long-term follow-up, which aims to evaluate the Taiwan. nationwide population-based association between Sjögren’s syndrome and os- Design A nationwide population-based retrospective cohort study. BMJ Open teonecrosis of the jaw (ONJ) after tooth extraction. 2019;9:e024655. doi:10.1136/ cohort study. ► The National Health Insurance Research Database Setting Data were extracted from Taiwan’s National bmjopen-2018-024655 registry could not provide detailed information re- Health Insurance Research Database (NHIRD). Prepublication history and garding laboratory results, family histories and ► Methodology Medical conditions for both the study and additional material for this health-related lifestyle factors. control group were categorised using the International paper are available online.
    [Show full text]
  • • Acute Pericoronitis • End-Stage Renal Disease • Acute Infectious Stomatitis an Acute Apical Abscess Should Not Be a Contraindication to Extraction
    • acute pericoronitis • end-stage renal disease • acute infectious stomatitis An acute apical abscess should not be a contraindication to extraction. It has been shown that these infections can resolve very quickly when the affected tooth is removed. However, it may be diffi - cult to extract such a tooth, either because the patient is unable to open sufficiently wide enough or because adequate local anesthesia cannot be obtained. There are few true contraindications to the extraction of teeth. Note: In some instances, the pa - tients’ health may be so compromised that they cannot withstand the surgical procedure. Examples of contraindications include: • End-stage renal disease • Severe uncontrolled metabolic diseases (i.e., uncontrolled diabetes mellitus) • Advanced cardiac conditions (unstable angina) • Patients with leukemia and lymphoma should be treated before extraction of teeth • Patients with hemophilia or platelet disorders should be treated before extraction of teeth • Patients with a history of head and neck cancer need to be treated with care because even minor surgery can lead to osteoradionecrosis. Note: These patients are often treated with hyperbaric oxygen therapy prior to (20 sessions) and following extractions (10 sessions). • Pericoronitis: infection of the soft tissues around a partially erupted mandibular third molar Note: This infection should be treated prior to removal of the maxillary third molar. • Acute infectious stomatitis and malignant disease are relative contraindications • Treatment with IV bisphosphonates increases the risk of osteonecrosis of the jaw Note: Causes of excessive bleeding after dental extractions include: injury to the inferior alveolar artery during extraction of a mandibular tooth (usually the third molar), a muscular arteriolar bleed from a flap procedure, or bleeding related to the patient’s history (i.e., patients who are on warfarin or drugs for platelet inhibition, patients who have hemophilia or von Willebrand disease, or who have chronic liver insufficiency)..
    [Show full text]
  • PATIENT FACT SHEET Osteonecrosis of the Jaw
    PATIENT FACT SHEET Osteonecrosis of the Jaw Osteonecrosis of the jaw (ONJ) is a condition where While there is a very low risk of ONJ occurring in people the jawbone is exposed and not covered by gums; a taking any of these medications, the risk may be slightly condition of poor healing. Bone weakens and dies. higher in people who require invasive dental procedures, There is no test to measure ONJ risk, but some factors such as a dental extraction or dental implant, if they also are known to raise this risk in very rare circumstances. take bisphosphonates. CONDITION Bisphosphonates, like alendronate (Fosamax), Patients who receive intravenous (injection into vein) DESCRIPTION risedronate (Actonel and Atelvia), ibandronate (Boniva), bisphosphonates as part of their cancer treatment are zoledronic acid (Reclast) and denosumab (Prolia), may at higher risk for ONJ than those who receive the much raise ONJ risk. This may be due to loss of bone’s ability to lower doses for osteoporosis treatment. Older age, repair itself, a drop in blood vessel formation or infection. diabetes, gum disease and smoking also raise ONJ risk. People with ONJ may experience pain, soft tissue swelling and drainage in the mouth, and an exposed jawbone for eight weeks or longer. Other possible signs are bad breath, loose teeth and signs of infection on gums. SIGNS/ SYMPTOMS People with osteoporosis who develop ONJ receive A rheumatologist has experience in treating osteoporosis conservative treatments, such as oral rinses, with antiresorptive medications and managing the risk antibiotics and oral analgesics to ease pain. These of osteonecrosis of the jaw.
    [Show full text]
  • Salivary Biomarkers and Their Application in the Diagnosis and Monitoring of the Most Common Oral Pathologies
    International Journal of Molecular Sciences Review Salivary Biomarkers and Their Application in the Diagnosis and Monitoring of the Most Common Oral Pathologies Lucía Melguizo-Rodríguez 1,2, Victor J. Costela-Ruiz 2,3, Francisco Javier Manzano-Moreno 2,4, Concepción Ruiz 2,3,5,* and Rebeca Illescas-Montes 2,3 1 Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences (Ceuta), University of Granada, 51001 Granada, Spain; [email protected] 2 Instituto Investigación Biosanitaria, ibs.Granada, 18012 Granada, Spain; [email protected] (V.J.C.-R.); [email protected] (F.J.M.-M.); [email protected] (R.I.-M.) 3 Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain 4 Biomedical Group (BIO277), Department of Stomatology, School of Dentistry, University of Granada, 18071 Granada, Spain 5 Institute of Neuroscience, University of Granada, 18016 Granada, Spain * Correspondence: [email protected]; Tel.: +34-958243497 Received: 17 June 2020; Accepted: 15 July 2020; Published: 21 July 2020 Abstract: Saliva is a highly versatile biological fluid that is easy to gather in a non-invasive manner—and the results of its analysis complement clinical and histopathological findings in the diagnosis of multiple diseases. The objective of this review was to offer an update on the contribution of salivary biomarkers to the diagnosis and prognosis of diseases of the oral cavity, including oral lichen planus, periodontitis, Sjögren’s syndrome, oral leukoplakia, peri-implantitis, and medication-related osteonecrosis of the jaw. Salivary biomarkers such as interleukins, growth factors, enzymes, and other biomolecules have proven useful in the diagnosis and follow-up of these diseases, facilitating the early evaluation of malignization risk and the monitoring of disease progression and response to treatment.
    [Show full text]
  • Oral and Maxillo-Facial Manifestations of Systemic Diseases: an Overview
    medicina Review Oral and Maxillo-Facial Manifestations of Systemic Diseases: An Overview Saverio Capodiferro *,† , Luisa Limongelli *,† and Gianfranco Favia Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy; [email protected] * Correspondence: [email protected] (S.C.); [email protected] (L.L.) † These authors contributed equally to the paper. Abstract: Many systemic (infective, genetic, autoimmune, neoplastic) diseases may involve the oral cavity and, more generally, the soft and hard tissues of the head and neck as primary or secondary localization. Primary onset in the oral cavity of both pediatric and adult diseases usually represents a true challenge for clinicians; their precocious detection is often difficult and requires a wide knowledge but surely results in the early diagnosis and therapy onset with an overall better prognosis and clinical outcomes. In the current paper, as for the topic of the current Special Issue, the authors present an overview on the most frequent clinical manifestations at the oral and maxillo-facial district of systemic disease. Keywords: oral cavity; head and neck; systemic disease; oral signs of systemic diseases; early diagnosis; differential diagnosis Citation: Capodiferro, S.; Limongelli, 1. Introduction L.; Favia, G. Oral and Maxillo-Facial Oral and maxillo-facial manifestations of systemic diseases represent an extensive and Manifestations of Systemic Diseases: fascinating study, which is mainly based on the knowledge that many signs and symptoms An Overview. Medicina 2021, 57, 271. as numerous systemic disorders may first present as or may be identified by head and https://doi.org/10.3390/ neck tissue changes.
    [Show full text]
  • Bisphosphonates, Osteonecrosis, Osteogenesis Imperfecta and Dental Extractions: a Case Series
    Clinical PRACTICE Bisphosphonates, Osteonecrosis, Osteogenesis Imperfecta and Dental Extractions: A Case Series Contact Author Stephane Schwartz, DDS, MSD, FRCD(C); Clara Joseph, DMD, MSc; Dr. Schwartz Deborah Iera, DDS, FRCD(C); Duy-Dat Vu, DMD, MSc, FRCD(C) Email: Stephane.Schwartz@ muhc.mcgill.ca ABSTRACT Over the past 4 years, numerous cases of osteonecrosis of the jaw in patients treated with bisphosphonates have been reported. Since 1998, children and adolescents with osteogenesis imperfecta have received bisphosphonates to increase their bone density and reduce the incidence of bone fractures. The results have been convincing, but recent reports of osteonecrosis of the jaw have caused great concern when these patients require dental extractions. The dental records of 15 children and adolescents with osteogenesis imperfecta, involving 60 dental extractions, mostly of primary teeth, done between 2001 and 2006, were reviewed. All patients but one had had or were having bisphosphonate treatment at the time of the extractions. No patient developed osteone- crosis. Further studies and data that allow clinicians to design adequate and safe treat- ment plans for this unique population are needed. For citation purposes, the electronic version is the definitive version of this article: www.cda-adc.ca/jcda/vol-74/issue-6/537.html he purpose of bisphosphonate therapy genesis imperfecta. Osteogenesis imper- is to slow the rate of bone resorption. fecta is often associated with severe dental TMostly, this therapy is used to treat dif- problems, such as dentinogenesis imperfecta ferent types of cancers (myelomas, metastatic (gray-brown friable teeth, bulky crowns and breast or prostate cancers), bone diseases or early calcification of the pulpal space) and severe osteoporosis.1,2 Since 2003, when the malocclusions (drastic open bites, impacted link between bisphosphonate therapy and bone molars; Figs.
    [Show full text]
  • Oral & Maxillofacial Surgery
    1 Oral & Maxillofacial Surgery Current Awareness Newsletter May 2015 2 Contents Your Friendly Local Librarian… ................................................................................................................ 2 New from the Cochrane Library of Systematic Reviews ......................................................................... 3 Recent Literature Searches on Oral and Maxillofacial Surgery............................................................... 3 Current Awareness Database Articles on Oral and Maxillofacial Surgery .............................................. 4 Oral surgery ......................................................................................................................................... 4 Bisphosphonate-related osteonecrosis of the jaw ............................................................................. 5 Maxillofacial ........................................................................................................................................ 7 Cleft lip and palate ............................................................................................................................ 11 Journal Tables of Contents .................................................................................................................... 15 Head and Neck .................................................................................................................................. 15 British Journal of Oral and Maxillofacial Surgery .............................................................................
    [Show full text]
  • Osteonecrosis of Jaw: Common Etiologies, Uncommon Treatments
    East Tennessee State University Digital Commons @ East Tennessee State University Appalachian Student Research Forum 2019 ASRF Schedule Apr 12th, 9:00 AM - 2:30 PM Osteonecrosis of Jaw: Common etiologies, uncommon treatments Utsab Panta Adam chan East Tennessee State University Debalina Das East Tennessee State University Follow this and additional works at: https://dc.etsu.edu/asrf Panta, Utsab; chan, Adam; and Das, Debalina, "Osteonecrosis of Jaw: Common etiologies, uncommon treatments" (2019). Appalachian Student Research Forum. 201. https://dc.etsu.edu/asrf/2019/schedule/201 This Oral Competitive is brought to you for free and open access by the Events at Digital Commons @ East Tennessee State University. It has been accepted for inclusion in Appalachian Student Research Forum by an authorized administrator of Digital Commons @ East Tennessee State University. For more information, please contact [email protected]. Osteonecrosis of Jaw: Common etiologies, uncommon treatments Utsab Raj Panta1, MD, Adam Chan1, Debalina Das1, MD, MPH 1East Tennessee State University, Department of Internal Medicine Introduction Case presentation continued Images Discussion continued First described in 2002, osteonecrosis of Later, patient complained of a piece of the jaw (ONJ, or avascular necrosis of the Case reports and series suggest benefit bone penetrating the skin of her chin and jaw) is an uncommon but potentially from hyperbaric oxygen therapy in wound presented with continuous drainage from serious side effect of treatment with healing, pain, and quality of life at three sinus tract in her mandible, which was bisphosphonates. Although months, however no significant diagnosed as osteonecrosis attributed to typically identified in patients with differences exist with outcomes beyond bisphosphonates, previous radiation multiple myeloma and other three months.
    [Show full text]
  • Prevention of Herpes Zoster Recommendations of the Advisory Committee on Immunization Practices (ACIP)
    Morbidity and Mortality Weekly Report www.cdc.gov/mmwr Recommendations and Reports June 6, 2008 / Vol. 57 / RR-5 Prevention of Herpes Zoster Recommendations of the Advisory Committee on Immunization Practices (ACIP) INSIDE: Continuing Education Examination depardepardepartment of health and human servicesvicesvices Centers for Disease Control and PreventionPrevention MMWR CONTENTS The MMWR series of publications is published by the Coordinating Center for Health Information and Service, Centers for Disease Introduction ..........................................................................1 Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. Methods ...............................................................................2 Background ..........................................................................2 Suggested Citation: Centers for Disease Control and Prevention. [Title]. MMWR Early Release 2008;57[Date]:[inclusive page numbers]. Biology of VZV ...................................................................2 Clinical Features of Zoster and PHN ..................................3 Centers for Disease Control and Prevention Diagnosis ..........................................................................5 Julie L. Gerberding, MD, MPH Director Zoster Transmission ...........................................................5 Tanja Popovic, MD, PhD Epidemiology of Zoster and Complications .......................6 Chief Science Officer Treatment and Nonspecific Management of Zoster
    [Show full text]
  • Oral Health in Elderly People Michèle J
    CHAPTER 8 Oral Health in Elderly People Michèle J. Saunders, DDS, MS, MPH and Chih-Ko Yeh, DDS As the first segment of the gastrointestinal system, the At the lips, the skin of the face is continuous with oral cavity provides the point of entry for nutrients. the mucous membranes of the oral cavity. The bulk The condition of the oral cavity, therefore, can facili- of the lips is formed by skeletal muscles and a variety tate or undermine nutritional status. If dietary habits of sensory receptors that judge the taste and tempera- are unfavorably influenced by poor oral health, nutri- ture of foods. Their reddish color is to the result of an tional status can be compromised. However, nutri- abundance of blood vessels near their surface. tional status can also contribute to or exacerbate oral The vestibule is the cleft that separates the lips disease. General well-being is related to health and and cheeks from the teeth and gingivae. When the disease states of the oral cavity as well as the rest of mouth is closed, the vestibule communicates with the the body. An awareness of this interrelationship is rest of the mouth through the space between the last essential when the clinician is working with the older molar teeth and the rami of the mandible. patient because the incidence of major dental prob- Thirty-two teeth normally are present in the lems and the frequency of chronic illness and phar- adult mouth: two incisors, one canine, two premo- macotherapy increase dramatically in older people. lars, and three molars in each half of the upper and lower jaws.
    [Show full text]
  • Oral Manifestations of Sjogrens Syndrome
    Review Oral manifestations of Rheumatology Future Sjögren’s syndrome Carol M Stewart† & Kathleen Berg †Author for correspondence: University of Florida Center for Orphaned Autoimmune Disorders, PO Box, 100414 JHMHC, University of Florida College of Dentistry, Gainesville, FL 32610, USA n Tel:. +1 352 392 6775 n Fax: +1 352 392 2507 n [email protected] Sjögren’s syndrome is a chronic autoimmune disease complex characterized by inflammation of the exocrine glands, primarily resulting in keratoconjunctivitis sicca, hyposalivation and xerostomia, or dry mouth. Dry mouth is one of the most easily recognized components and may lead the clinician to diagnosis. Hyposalivation is more than an inconvenience, having a significant adverse effect on health and quality of life. Early recognition of this condition may minimize some of the adverse sequelae. A dental evaluation in patients with confirmed or suspected Sjögren’s is recommended. The focus of this review article is to highlight oral manifestations of Sjögren’s syndrome to include pathogenesis, clinical presentation, implications for health, diagnostic tools, management strategies and future perspectives. CME Medscape: Continuing Medical Education Online Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. Medscape, LLC designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation.
    [Show full text]
  • Drug-Induced Osteonecrosis of the Jaw
    short review memo (2012) Vol. 5: 57–62 DOI 10.1007/s12254-012-0328-1 Printed in Austria memo magazine of european medical oncology © Springer-Verlag 2012 Drug-induced osteonecrosis of the jaw P. Bergmeister1,2,3, K. Gasser1,2,3 and A. Lang1,3 1Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria 2Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein 3Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria Received 19 November 2011; accepted 17 January 2012 With the increasing use of intravenous bisphosphonates in bone pain and skeletal-related events (SRE) in patients with oncological settings, osteonecrosis of the jaw is now a more metastatic bone disease secondary to multiple myeloma, common and often devastating complication which, in an ad- breast cancer or prostate cancer. Skeletal-related events in- vanced stage, signifi cantly impacts the quality of life. Since clude any secondary complication from the presence of bone management and therapy of osteonecrosis present major metastases such as radiation therapy to reduce pain or pre- challenges, more attention should be focused on the assess- vent fracture, bone surgery to treat or prevent fractures, and ment of risk and preventive measures. In recent years bisphos- pathologic fracture or spinal cord compression that can result phonate treatment, especially its intravenous application, has in paraesthesias, incontinence, and paralysis [1, 2]. Over the been identifi ed as the main cause of osteonecrosis of the jaw. past few years, because of growing positive clinical evidence, However, denosumab, a novel and promising agent in treating the use of bisphosphonates dramatically increased, especial- metastatic bone disease and osteoporosis, also increases risks.
    [Show full text]